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Chest Pain

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  • Good day. The members of Team C are going to present a Power Point presentation on the learning needs of the staff for a local community hospital regarding Chest Pain: What the Staff Needs to Know.
  • The hospital is located in a small retirement community. The emergency center of the hospital has 24 beds. The staffs vary from emergency room nurses, nursing assistants/technicians, and ancillary staff including volunteers, housekeeping, and registration clerks. The hospital also provides opportunities for the nursing students to rotate in the different department for the clinical rotation. Numerous patients present to emergency rooms around the country for signs and symptoms related to chest pain; therefore, continuing education regarding chest pain is beneficial to all emergency room staff. More than 40 percent of the cases brought in the emergency center of the community hospital are related to chest pain. Every staff has different responsibilities in how to handle patients that seek treatment for chest pain. Chest pain occurs in over 1,000,000 people in a single year and almost 40% of those will die from it (American Heart Association, 2008). The importance of time in dealing with patients that come in with complaints of chest pain should be stressed. Chest pain can be life threatening therefore, immediate medical attention needs to be obtained and prompt action from the healthcare providers is deemed necessary.
  • As an educational consultant for a local community hospital’s emergency room, curriculum objectives have been identified for emergency room nurses, student nurses, nursing assistants/technicians, and all ancillary staff including volunteers, housekeeping, and registration. The ancillary staff will be provided with a brief overview in case they encounter a patient who presents with chest pain and no nurse is available. The hospital staff needs to be educated according to their learning requirements in order to recognize effectively and treat those that are experiencing chest pain in a timely manner. Learning methods that provide effective staff education should take into consideration the varying learning types such as auditory, visual, and kinesthetic. By identifying these types of learners among emergency room staff the hospital will be able to take full advantage of the staffs’ potential (Farwell, 2008).  
  • When it comes to developing an educational program for learning, cultural sensitivity specifically gender related issues becomes an important aspect of the process. With this in mind, the educator needs to be sensitive to the needs of both the female and male learning needs. In order to understand what culture is we need to characterize it. Culture as defined by Madeline Leininger, a nursing theorist, is “the lifeways of an individual or group with reference to values, beliefs, norms, patterns, and practices that are learned, shared, and transmitted intergenerationally” (Leininger, 1997, p. 50 ). This definition proves that every staff member that will be a part of this learning program will have differences in one way or another. DeYoung (2003) discusses the differences in gender to be that of experiences and socialization as well as social status. To provide a learning environment that is conducive in sharing and socializing is a good idea. Most men are fond of multiple learning styles and transition easily between them whereas most women prefer one learning style (Wehrwein et al, 2007). With this in mind, the educator needs to be willing to incorporate all learning styles while teaching. Men are more direct whereas women talk around a topic (Wehrwein et al). Men like to get to the point where women like to provide all the details (Wehrwein et al). Men are competitive in nature and women enjoy working with others (Wehrwein et al). Men are rational and women are socially focused. Men like to surpass their personal goals whereas women like to see how they are currently doing (Wehrwein et al). Men base their performance on outward experiences such as the educator and how they did where as women as critical of themselves and what they did wrong (Wehrwein et al).
  • Today there is a wide gap of generations working together. In the past people were use to working with others that had the same generational values, perspectives and historical life experiences. These common experiences are what bound the working group together. (Blythe et al, 2008). Today there are actually four different generations working together and with this comes difficulty in education attempting to provide each generation their specific learning needs. (Blythe et al) The four generations currently working together include the Veterans, the Baby boomers, Generation X-ers, and Generation Y-ers or Generation Next (Blythe et al). The Veterans are the oldest generation in the current workforce with birthdays starting in 1925 to 1945. The Baby Boomers are the second oldest group with Birthdays starting in 1946 to 1964. Generation X is the third oldest born between 1963 to 1984. The youngest generation is that of the Generation Y and their birthdays start in 1980-1999 (Blythe et al, 2008). The Veterans value rules and are seen as very conservative. They tend to be more loyal especially to employment institutions and enjoy team work with leadership already established. This generation favors communication in person and values hard work which they feel should be compensated for accordingly (Blythe et al, 2008). The Baby Boomers are the largest part of the current staff with a very different approach to life than that of the Veterans. Baby Boomers believe in sharing their opinion even if it is different from others and at times can be harsh on those that believe differently. Baby Boomers have a lack of respect especially when it comes to authority figures. They are known as workaholics that are ambitious and have high career goals (Blythe et al). The Generation X-ers value risk taking and because of this they are use to change, they see education as a means to continue to compete in the work force. Their outlook in life is more pessimistic and has no problem leaving a company if their circumstances change. They are self absorbed and they are deliberate with commitments. They feel their personal life is just as important as their career. Generation X-ers are fond of technology and are able to make use of the technology in their professional life. Generation X-ers also value diversity (Blythe et al). Generation Y-ers coexist with technology. They love to learn and are always looking to better themselves. Generation Y-ers or Generation Next are independent, sociable, optimistic, and value honesty. They focus on achieving personal and professional goals and are very confident. Generation Y-ers love teamwork and value positive criticism. Generation Y-ers value hard work, but feel they should be compensated for doing so (Blythe et al). Blythe et al (2008) recognizes that these generational gaps cause conflict amongst the staff. They found that this conflict is evident through topics such as work ethic, seniority, and behavior (Blythe et al). Knowing these conflicts before attempting to educate one can attempt to recognize the needs of the staff and plan accordingly to create cohesiveness amongst the staff. Knowing the specific educational needs of each generation will provide the utmost learning experience allowable. The use of technology will be much easier to incorporate into an educational program for those that come from the Generation X and Y, but will be more difficult for the Baby Boomers and especially difficult for the Veterans. The educator will need to plan appropriate time intervals if technology will be used to be able to appropriately intervene for the older generations. The Veteran generation values personal forms of communication, making lectures and class discussions more understandable, rather than e-learning options that is available. If change is what is needed to bring about a new educational program than using the latter two generations for assistance is a good idea. Learning comes in different forms and because of this generational issues need to be assessed so that the education being given will reach its full potential.
  • Learning barriers are important to identify before attempting to teach a concept. Adults in particular have many barriers that can cause a lack of participation. Russell (2006) identifies seven barriers including “lack of time, lack of confidence, lack of information about opportunities to learn, scheduling problems, and environmental, emotional, and hearing or visual impairments” (p. 352). In order to prevent or set aside these barriers, the staff needs to be motivated to learn and the educator must be aware of these to support the learning process. If the staff does not recognize these barriers, the learning of a new topic will be hindered (Russell). The educator and the institution can ensure that the environmental barriers are non-existent by providing a facility accommodating to learning. The temperature and lighting of the room can have an impact on the learning that does or does not take place (Russell, 2006). The institution and educator can also make sure that there are limited distractions such as other noises that would impact the learning process (Russell). For the hearing and visually impaired, the educator can guarantee a spot for the staff in the front of the classroom making it possible for learning to take place (Russell). The institution must also provide only those educators that are knowledgeable and trained to teach specific material to ensure that the staff will respect the educator (Russell).
  • By the year 2050, Caucasians will account for less than 50% of the U.S. population (Walsh, 2004, p. 19). Providing education and training based upon the culturally diverse needs among all healthcare levels challenges healthcare educators of today. “Designing educational process includes… the physical, cognitive, cultural, social and economic characteristics of the [individual] being taught with … educational resources are available in a form based on learning needs” (Walsh, p. 20). Understanding and respecting the diverse needs of the student population of a teaching session allows the educator to become actively aware and flexible with the lesson plan for the material being presented. Additionally, the instructor needs to provide education to a diverse population of healthcare workers in a nondiscriminatory environment that is conducive to a supportive environment where the student feels at ease to seek further clarification without judgmental preconceptions based on the suggested diverse factors outlined: language; knowledge and skill level; physical and mental challenges; social beliefs; economic factors; sprit and psychosocial values. More importantly is the ability of the healthcare worker to identify and work through their own individual biases. “This means that one has to focus on developing the ability to negotiate cultural diversity” (Scott, 2001, p. 1). Recognizing preconceived thoughts and judgments by the individual student allows the student to break down any barriers that may inhibit them from being completely open to the learning experience. By developing a multicultural perspective, the educator is cultivating experience through perceiving, evaluating, believing, and doing (Scott, p. 1).
  • Adults learn in very different ways so in order to educate one’s staff the educator must know how to best incorporate the teaching process to maximize the benefits of learning for all that are involved. Providing a wide range use of these teaching principles can almost guarantee that each staff member will walk away learning something. The first step in creating a new educational program for staff is to assess the learning style of the learners to determine the level of effectiveness of the education (Russell, 2006). Three types of learning styles are noted and most staff will fall into one or a combination of these styles. These learning styles consist of visual, auditory, and kinesthetic learning. Visual learning is the first type learning style where these learners make use of their eyes to assist in the learning process. They favor pictures and charts as well as written materials. Suggestions for the educator are to present the information making full use of charts, graphs, and pictures. Handouts that are organized and attractive visually will also benefit the visual learner. Another way to assist in the learning process of a visual learner is by using the computer, videos, and PowerPoint (Russell, 2006). The second type of learning style is that of an Auditory style. These types of learners listen to others well and learn by repetition and discussion. The educator can assist this learning style by rewording the key concepts and questions asked in order to pass on understanding. The educator can also use music and speech tones and pitches to offer a variety of sounds. Knowing who is an auditory learner is a good idea so that suggestions for sitting near the front of the class can be made in order to ensure that hearing is not an issue (Russell, 2006). The third type of learning style is that of the kinesthetic learner. These learners use the sense of touch to help them in their learning process. They prefer to learn hands on with new machinery or materials and after learning the new concept; will never have to learn it again. The kinesthetic learner is coordinated and prefers to keep moving rather than sitting still. The best intervention an educator can provide in assisting this type of learning style is allowing numerous breaks throughout the learning session. These types of learners also learn well by moving around or even walking around in the room during the session. Kinesthetic learners enjoy presentation by teachers and other staff members and especially like using computers and other types of machines or products to learn what they are teaching (Russell, 2006). The educational program will be developed based upon the learning needs of the staff. Since three types of learning styles are present, all materials will include details so that all learners will be appealed to. The visual learners will be attracted to the lecture notes provided by the educator that include many colors and organized information. Handouts of PowerPoint presentations will be given as well as copies of the PowerPoint lecture slides. The educator will use their voice in a way that appeals to the auditory learner with lack of monotony. Videos and music will also be used to integrate the concepts. For the kinesthetic learner, the educator will use return demonstrations and computer to assist in the teaching of the material.
  • Needs assessment: Define goals to be reached and functions to be performed with the learners or program needs. Development of objectives: Needs and constraints suitable for ongoing and product analysis. Constraints and capabilities: Various types of constraints with the program and resources and new approaches that may be needed to implement the program. Planning the instructional program activities: Develop a plan based on environment and learner needs and interests. Examine learners by who are they, what brings them to the learning setting, how do they learn? Examine content plans by what is being studied, why is it being studied, the importance of the subject? Examine educational resources as to what is available or need to assist in the learning experience. Examine method by what are the needed or required patterns of the organization, how many learners there are, how much time is available, and what are the physical restraints. Implementing the instructional program: Using a lecture with knowledge, skills and needs to be learned. How much time is needed for the preparation of the lecture should be evaluated. Being in command of the instructors’ nonverbal cues and how to develop interest with the subject within the lecture. When and what appropriate audio-visual tools are to be used. Development of a handout to go along with the lecture material. Provide an outline of the important parts of the lecture. Be able to summarize regularly in the lecture and pose questions to the learners throughout the lecture. Creating demonstrations to emphasize the material being taught especially if the learners need to see the process. By using demonstration method with lecture can develop a tell and show method. There must be the tools needed to do the demonstration at hand and ready. With the demonstration, instructors need to ask questions and allow question by learners to clarify what is being demonstrated. Demonstrations should have practice time for the learners to ensure learners can easily identify steps demonstrated. Handouts of the demonstration and concepts should be handed out. Evaluation of instructional program effectiveness: Evaluation can be done by post tests and having learner demonstrates what has been shown to them. An evaluation form at the end of the class will be handed out to learners to access how the program was effective.
  • Kemp Design Model: An oval shaped model that gives the designer the sense that the model is a continuous cycle that requires constant planning, design, development, and assessment to insure effective instruction. It encourages designers to work in all areas. By using the nine elements of the Kemp Design Model, the needs for the implementation of the lecture and demonstration methods will be met in all aspects for an effective learning presentation.
  • A learning need regarding education about chest pain has been identified. The topic outline presented is the suggested guide in the staff education about chest pain. Variations on how the topic is presented will depend on the audience presented to and the level of care the audience is responsible. A hand out regarding the topic will be provided to the audience before the class starts to guide the audience.
  • Immediate evaluation of outcomes for any educational experience provides insight for both the teacher and the student for which objectives were or were not met. The most effective tool or evaluation of objectives is the use of direct observation of a clinical interaction between the healthcare worker and a patient. The teacher can provide immediate feedback to the student on matters that may need improvement as well as positive feedback for interactions completed correctly. One tool used for evaluating direct observation of interactions between the healthcare worker and the patient is a mini clinical evaluation exercise (mini-CEX) (Nair, 2008, p. 159). “The mini-CEX involves direct observation of a trainee in a focused clinical encounter, followed by immediate feedback” (Nair, p. 159). In evaluating the skills listed, the evaluator rates the trainee based on met expectations, borderline, or did not meet expectations (Nair, p. 159). This particular evaluation tool is found to be beneficial due to the immediate feedback presented during the observation experience. In addition to evaluating the student, the educator should be evaluating their perception of meeting the objectives and how they will apply the learned information. Questions that can aid in the student in evaluating outcomes include (Rae, 2004, p. 2): To what extent do you feel you have learned from the program? What have you not learned that you needed to and/or expected to learn? List three action plan items you intend to implement from the content of the educational lesson provided? Thirdly, the instructor should evaluate their perception of how the lesson plan was presented and received. The following are queries to allow for such an assessment: Did our pre- and post-assessments of students show that they learned? Explain why or why not. Did our lesson plan allow ALL staff to learn? Explain why or why not. Did our lesson increase or reduce prejudices in the classroom? Explain why or why not. What would we do differently next time?
  • Transcript

    • 1. Chest Pain: What the Staff Needs to Know Angie Rotert, Brooke Piper, Dorothy Alford, Kathryn Taylor University of Phoenix NUR 588
    • 2. Audience and Demographic Information• local community hospital emergency department• emergency room nurses• student nurses• nursing assistants/technicians• ancillary staff including volunteers, housekeeping, and registration
    • 3. Employer Needs
    • 4. Gender & Generation IssuesIndirect Communication Direct CommunicationDetailed / Elaborative ConciseCooperation CompetitiveOrganized Activities IndividualisticSociable LogicalPerformance Oriented Goal OrientedInwardly Focused Outwardly Focused
    • 5. The Generational Gap Baby BoomersVeterans Workplace Generation X-ers Generation Y-ers
    • 6. Learning Barriers
    • 7. Population Diversity• Factors to consider when developing educational material for diverse populations of healthcare workers: (Walsh, 2004) – Language – Knowledge and skill level – Physical and mental challenges – Social beliefs – Economic factors – Spirit and psychosocial values• Nondiscriminatory environment• Healthcare worker to identify their own biases• Develop a multicultural perspective (Scott, 2001): – Requires dialogue between individuals – Respecting different points of views – Reorganization of different experiences – Respect for diverse opinions
    • 8. Staff Education
    • 9. Teaching Methods• Needs assessment• Development of objectives• Constraints and capabilities• Planning the instructional program activities• Implementing the instructional program• Evaluation of instructional program effectiveness
    • 10. Teaching Methods• Identify instructional problems and specify goals for designing an institutional program.• Examine learner characteristics that should receive attention during planning.• Identify subject content and analyze task components related to stated goals and purposes.• State instructional objectives for the learner.• Sequence content within each institutional unit for logical learning.• Design instructional strategies so that each learner can master the objectives.• Plan the instructional message and delivery.• Develop evaluation instruments to access objectives.• Select resources to support instruction and learning activities.
    • 11. Topic Outline: Chest Pain: What the Staff Needs to KnowI. Introduction I. Psychomotor SkillsII. Definition of terms 1. Demonstration on EKG 1. Chest pain 2. Practice for audience 2. Electrocardiogram II. Understanding RhythmIII. Understanding chest pain Strips (for RNs and nursing 1. Physiology students) 2. Who are at risk 1. Present samples of the different rhythms one by one and define 3. Signs and symptoms each. 4. Initial assessment 2. Underlying physiology behind 5. Continuous monitoring abnormal rhythms.IV. Electrocardiogram (EKG) III. Summary of topics 1. What is EKG IV. Evaluation 2. What is the purpose of an EKG 1. Written 3. How to perform an EKG 2. Psychomotor skills check off 4. How to interpret an EKG
    • 12. Tools for Evaluation of Objectives – Direct observation of interactions between healthcare worker and chest pain patient. - Mini Clinical Evaluation Exercise (mini-CEX) (Nair, 2008, p. 159) • Skills evaluated: Patient interview Physical examination Professionalism/humanistic qualities Counseling Clinical judgment Organization and efficiency Overall clinical competence- Student’s evaluation of program- Instructor’s evaluation of program
    • 13. ReferencesAbrums, M. E., & Leppa, G. (2001). Beyond cultural competence: Teaching about race, gender, class and sexual orientation. Journal of Nursing Education, 40(6), 270–275. Retrieved October 11, 2008 from ProQuest.American Heart Association. (2008). Heart attack and angina statistics. Retrieved October 5, 2008, from http://www.americanheart.org.Blythe, J., Baumann, A., Zeytinoglu, I., Denton, M., Akhtar-Danesh, N., Davies, S., Kolotylo, C. (2008). Nursing Generations in the Contemporary Workplace. Public Personnel Management 37(2), 137-159. Retrieved October 11, 2008 from EBSCOhost.Brown, S., Kirkpatrick, M., Mangum, D., Avery, J. (2008). A review of narrative pedagogy strategies to transform traditional nursing education. Journal of Nursing Education, 47(6), 283-286. Retrieved October 11, 2008 from EBSCOhost.Farwell, T. (2008). Visual, auditory, kinesthetic learners. Retrieved October 5, 2008, from http://school.familyeducation.com/intelligence/teaching-methods/38519.htmlLeininger, M. (1997). Overview of the theory of culture care with the ethnonursing research method. Journal of Transcultural Nursing, 8(2), 32-52. Retrieved October 11, 2008 from SAGE Journals.Hiemstra, R. (2008). The process of the design of instruction. Retrieved October 23, 2008, from http://home.twcny.rr.com/hiemstra/instproc.html
    • 14. ReferencesNair, B., Alexander, H., McGrath, B., & Parvathy, M. (2008). The mini clinical evaluation exercise (mini-CEX) for assessing clinical performance of international medical graduates. Medical Journal of Australia, 189(3), 159. Retrieved October 23, 2008, from http://proquest.umi.com.ezproxy.apollolibrary.com/pqdweb? did=1527823561&sid=1&Fmt=2&clientId=13118&RQT=309&VName=PQD.Rae, L. (2004). Evaluation of training and learning. Retrieved October 20, 2008, from Businessballs.com: http://www.businessballs.com/trainingevaluationtools.pdf.Russell, S. (2006). An overview of adult-learning processes. Urologic Nursing, 26(5), 349-370. Retrieved October 11, 2008 from EBSCOhost.Scott, J. (2001). Meeting the diverse needs of all students. Retrieved October 23, 2008, from Houghton Mufflin Company: http://www.eduplace.com/science/profdev/articles/scott.htmlStrickland, A. (2008). Idaho State University College of Education. Instructional systems design models. Retrieved October 23, 2008, from http://ed.isu.edu/depts/imt/isdmodels/index.htmlVanga Teachers College. (2005). Learn by doing. Student workbook module B. Teaching skills. Retrieved October 23, 2008, from http://www.schoolnet.net.sb/courses/Vanga/ Vanga_%20Module_%20B/unit_b5__methods_of_learning__teaching.html
    • 15. ReferencesWalsh, S. (2004). Formulation of a plan of care for culturally diverse patients. International Journal of Nursing Terminologies and Classifications, 15(1), 17. Retrieved October 23, 2008, from http://proquest.umi.com.ezproxy.apollolibrary.com/ pqdweb?did=637344341&sid=5&Fmt=2&clientId=13118&RQT=309&VName=PQD.Wehrwein, E., Lujan, H., & DiCarlo, S. (2007). Gender differences in learning style preferences among undergraduate physiology students. Advances in Physiology Education, 31, 153-157. doi:10.1152

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